Social, Ethical and Treatment Related Problems Faced by Healthcare Workers in the Care of Head and Neck Cancer Patients: A Narrative Review from the Bioethics Consortium from India.

Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties.

Assessment of quality of life (QOL) in cancer patients attending oncology unit of a Teaching Hospital in Bangladesh.

BACKGROUND: The quality of life (QoL) of a cancer patient is their perception of their physical, functional, psychological, and social well-being. QoL is one of the most important factors to consider when treating someone with cancer and during follow-up. The aim of this study was to understand the state of QoL among cancer patients in Bangladesh and to determine the factors that affect it. METHODS: This cross-sectional study was conducted on 210 cancer patients who attended the oncology unit of Delta Medical College & Hospital, Dhaka during the period between 1 May 2022 and 31 August 2022. Data were collected using the Bengali version of the European Organization for Research and Treatment of Cancer (EORTC) questionnaire. RESULTS: The study reported a high number of female cancer patients (67.6%), who were married, Muslims by religion, and non-residents of Dhaka. Breast cancer was more common among women (31.43%), while lung and upper respiratory tract cancer was more prevalent among men (19.05%). The majority of the patients (86.19%) were diagnosed with cancer in the past year. The overall mean score for functional scales was higher for physical functioning (54.92) whereas it was lower for social functioning (38.89). The highest score on the symptom scale was for financial problems (63.02), while the lowest was for diarrhea (33.01). The overall QoL score of cancer patients in the study was 47.98 and it was lower for males (45.71) compared to females (49.10). CONCLUSIONS: The overall QoL was poor among Bangladeshi cancer patients compared to those in developed countries. A low QoL score was observed for social and emotional functions. Financial difficulty was the main reason behind the lower QoL score on the symptom scale.

Bibliometric analysis of the literature on von Willebrand disease: Research status and trends.

BACKGROUND AND AIM: Von Willebrand disease (VWD) is considered the most prevalent inherited bleeding disorder. The current study aims to demonstrate the research status and trends on VWD worldwide. METHODS: Bibliometric analysis was used to investigate the global research productivity and trends on VWD. The publications on VWD from 1956 to 2021 were extracted using the Web of Science database. In the VWD domain, a total of 3,643 records were analyzed for authorship and collaboration patterns, yearly productivity, highly cited documents, relevant source of publication, most prolific scholars, productive countries, and organizations. RESULTS: The most productive journal, author, organization, and country were 'Haemophilia' with 439 publications, 'Favaloro EJ' with 119 publications, the 'University of Milan' with 192 publications, and the United States of America (USA) with 1,048 publications, respectively. The document with the highest citations was 'Srivastava A, 2013, Haemophilia,' which received 1,154 citations in total. In 2016, the highest number of publications shared by two author patterns was 28. With 199 publications, the year 2021 remained on the top, while the citation-wise analysis identified 2006 as the top year with 5,379 citations. CONCLUSIONS: Research productivity and publication trends on VWD revealed that the USA emerged as the most significant contributing country. The 'University of Milan' was the most significant contributing organization, while 'Favaloro EJ' was the most significant author. 'Hemophilia' was found to be the most significant journal in the field of VWD. It is recommended that researchers from countries with significant contributions to the field should collaborate with researchers from Asian countries and other countries that lack behind in research in the domain of VWD.(www.actabiomedica.it).

Open Surgical Tracheostomy in COVID 19 Patients and Their Outcomes During the Second Wave in India: Experience at a Tertiary Referral Centre.

Tracheostomy in COVID-19 is a debatable topic, with guidelines and recommendations evolving with every wave. Tracheostomy can help early weaning and potentially increase the availability of ICU beds. The aim of our study was to determine the outcomes of patients undergoing tracheostomy at different timings. This was an ambispective observational descriptive longitudinal study of patients confirmed to have COVID-19 by real- time reverse transcriptase polymerase chain reaction (RT-PCR) admitted in the ICU and needed intubation for mechanical ventilation and underwent tracheostomy at a tertiary referral centre. This study was over a period of two months from May to June 2021. A total of 169 patients were admitted to the ICU for COVID-19 from May to June 2021 out of which 27 patients underwent open surgical tracheostomy. Study included almost equal number of male and female patients. The most frequent comorbidities were hypertension and diabetes. The majority of patients were between 5th and 7th decades of life (59.2%; 16 patients). The common indications for tracheostomy were acute respiratory distress syndrome, failure to wean from ventilation, sedation management, difficult airway, and persistent airway oedema. Five patients (18.5%) underwent tracheostomy on day 8, the maximum number on a single day. The earliest tracheostomy was done on day 3 and the latest on day 17 with variable results. There were 6 survivors out of 27, youngest being a 27-year-old female and oldest a 60-year-old male. Our study showed that there was no association of age, sex of the patients and presence of comorbid conditions with the timing of intubation. Clinical outcome of the patients also was not affected by the any of the socio clinical variables viz. age, sex of the patient, presence of comorbid conditions and timing of intubation. Tracheostomy in COVID-19 is an aerosol generating procedure; strict recommendations and guidelines need to be followed.

A Rare Case of Sphenoid Sinus Mucocele Presenting with Lateral Rectus Palsy.

The sphenoid sinus mucoceles are rare and have an incidence of 1%, when sufficiently large they can compress optic canal, superior orbital fissure and vital structures causing optic neuropathy, ptosis, ophthalmoplegia and diplopia. We herein report a 73 year old male who presented with headache and left lateral rectus palsy secondary to sphenoid sinus mucocele which was confirmed on MRI and successfully treated with endoscopic marsupialization.

Impact of achieving euthyroidism on pulmonary artery systolic pressures in hyperthyroidism-associated pulmonary hypertension - a systematic review.

In this systematic review, we seek to clarify the impact of treatment of hyperthyroidism on pulmonary hypertension in patients with both these conditions. We included 39 of 709 articles retrieved, that studied patients with hyperthyroidism and pulmonary hypertension (PH). From these, those with a documented pre-treatment Pulmonary Artery Systolic Pressure (PASP) > 35 mmHg and complete follow up were analyzed, yielding 3 case series and 22 case reports with a total of 81 cases. A significant improvement in PASP was noted with achieving euthyroidism in the 3 case series. The case reports showed a significant reduction in mean PASP from 60.5 ± 13.2 mmHg to 37.5 ± 10.1 mmHg (p < 0.001) in patients with Grave's disease with achieving euthyroidism. No deaths were reported during the follow up period. Achievement of a euthyroid state in patients with hyperthyroidism is associated with statistically significant reductions in PASP.

Research productivity in the genetics of papillary thyroid carcinoma (1991-2020): a bibliometric analysis.

BACKGROUND AND AIM: Papillary thyroid carcinoma accounts for 85% of thyroid follicular epithelial-derived cancers. The identification of pathogenetic mechanisms improved the understating of papillary thyroid carcinoma pathogenesis. The current study aims to examine the research productivity and trends in the genetics of papillary thyroid carcinoma from 1991 to 2020. METHODS: The Web of Science Core Collection database was searched to retrieve the relevant literature. A search string was applied and 1,741 relevant records were selected for the analysis. Bibliometric techniques were used in the statistical analysis with the help of Biblioshiny (RStudio). RESULTS: The growth in the number of publications was observed to be over a hundred publications per year since 2015. 'Thyroid' published the highest number of publications, followed by 'Journal of Clinical Endocrinology & Metabolism'. 'Nikiforov YE' was identified as the most productive researcher with a total of 49 publications. Out of the top 20 most contributing researchers, seven belonged to Italy, and four were from the USA. 'University of Pittsburgh' contributed the highest number of publications. The top contributing countries in this field were the USA, China, and Italy. BRAF and RAS were among the frequently used keywords. CONCLUSIONS: This bibliometric review demonstrates that investigating the genetics underlying papillary thyroid carcinoma is a rapidly growing area of research. During the last two decades, China has been a significant contributor to the field. Besides, institutions in USA and Italy have significantly contributed to research in the genetics of papillary thyroid carcinoma. (www.actabiomedica.it).

The nose as a feature of forensic practice.

The nose is a prominent facial structure which is too often overlooked by forensic medicine practitioners. Studies that consider the role of the nose in forensic practice are scattered throughout scientific literature. We provide a brief review of these.

Analysis of Disease Patterns in Patients with Unilateral Sinonasal Diseases: A Tertiary Care Hospital Experience.

AIMS: The aim of the present study was to evaluate the clinicopathological profile of sinonasal masses and to identify features suggestive of neoplastic pathology. MATERIALS AND METHODS: A retrospective review of all sinonasal masses in patients attending a tertiary care hospital between April 2019 to Feb 2020 presenting at a tertiary care hospital were analysed. The demographic data, presenting symptoms, radiological and histopathological diagnosis were analysed. RESULTS: In the present study total 23 patients with age ranging from 8 to 72 years were analysed. The overall M:F ratio was 1.55:1. Most of the patients (56%) belong to 31-60 year age group. The main presenting symptoms were nasal obstruction and rhinorrhoea. Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be higher in neoplastic conditions. The number of non-neoplastic lesions were more than neoplastic with 78.2% being reported to be antrochoanal polyp and ethmoidal polyps, 8.69% being inverted papillomas and 13% cases were histopathologically reported to be malignant. Neoplastic conditions were significantly commoner in males and in the age group 40-60 years. CONCLUSION: We concluded that clinical, radiologic, and histopathological evaluation is essential for proper diagnosis and stress the importance of immunohistochemistry which is the ultimate diagnostic technique in certain neoplastic lesions.

Knowledge and Attitude Towards Cardiopulmonary Resuscitation Among Doctors of a Tertiary Care Hospital in Karachi.

Objective Cardiac arrest is an emergency, which can be managed effectively by sound knowledge and practice of basic life support (BLS) skills. However, it has been globally reported that the knowledge of doctors regarding cardiopulmonary resuscitation (CPR) and BLS is sub-standard. We conducted this study with the aim to assess the knowledge and attitude of doctors toward CPR in Dr. Ruth K.M. Pfau Civil Hospital, one of the largest tertiary care hospitals, in Pakistan. Methods We conducted a cross-sectional study, in Dr. Ruth K.M. Pfau Civil Hospital located in Karachi, Pakistan, using cluster sampling. A total of 285 doctors were interviewed. Results A majority of the doctors were unaware of the revised rate and depth of chest compressions (65.6% and 75.8% respectively). While many know the abbreviations of BLS and CPR (96.55% and 95.4%, respectively), 56.5% did not know what automated external defibrillator (AED) stood for. CPR was preferred over chest compression-only resuscitation (CCR) by 91.6% of the doctors. Half of the participants rated their knowledge as average. Most stated that they will not be reluctant to perform CPR in an emergency situation. The majority also agreed that BLS training should be an integral part of the medical curriculum. Conclusion There is an evident lack of knowledge of CPR among healthcare professionals, particularly regarding the updates made in the 2015 American Heart Association (AHA) guidelines. However, an overall positive attitude was observed.

A Rare Case of Adenoid Cystic Carcinoma of the Sphenoid Sinus Presenting with Lateral Rectus Palsy.

A rare case of adenoid cystic carcinoma arising from the sphenoid sinus causing lateral rectus palsy is presented here. Adenoid cystic carcinoma of the paranasal sinuses is an aggressive neoplasm which needs early diagnosis and treatment. Ideal treatment paradigm for paranasal sinus tumors is yet to be established. A combination of surgery and radiotherapy offers a better disease control and survival.

Breaking your heart-A review on CPR-related injuries.

Cardiopulmonary resuscitation (CPR) has been shown to increase survival after cardiac arrest, but is associated with the risk of acquired injuries to the patient. While traumatic chest wall injuries are most common, other injuries include upper airway, pulmonary and intra-abdominal injuries. This review discusses the risk factors and prevalence of CPR-related injuries.

Authorship: Few Myths and Misconceptions.

This article seeks to address and dispel some of the popular myths and misconceptions surrounding authorship of a scientific publication as this is often misconstrued by beginners in academia especially those in the developing world. While ethical issues in publishing related to authorship have been increasingly discussed, not much has been written about the myths and misconceptions of who might be an author. Dispelling these myths and misconceptions would go a long way in shaping the thoughts and plans of students, junior faculty and researchers in academia especially in the developing world.

Role of concomitant chemoradiation in locally advanced head and neck cancers.

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

An autopsy case of iatrogenic tracheoesophageal fistula secondary to tracheostomy.

Tracheoesophageal fistula (TEF) is an uncommon but life-threatening sequel of prolonged use of a cuffed tracheostomy tube. We describe a patient who developed a TEF after a tracheostomy done for management of head injury due to a road traffic mishap. The patient subsequently died of sepsis after bilateral bronchopneumonia. To the best of our knowledge, this is the first autopsy case of iatrogenic TEF after tracheal intubation reported in forensic literature.

Clinicopathological profile of head and neck cancers in the Western development region, Nepal: a 4-year snapshot.

Regional cancer epidemiology is an important basis for determining the priorities for cancer control in different countries worldwide. There is no reliable information about the pattern of head and neck cancer in western Nepal and hence an attempt was here made to evaluate the situation based on hospital data, which provide the only source in the western region of Nepal. A clinicopathological analysis of head and neck cancers treated between 2003 and 2006 in Manipal Teaching Hospital affiliated to Manipal College of Medical Sciences, Pokhara, Western Development Region, Nepal was performed. A total of 105 head and neck cancer cases were identified with a male to female ratio of 1.8:1. The median ages of male and female patients were 62 and 64 years, respectively. Ninety-seven (92.4%) of the cancer patients were suffering from carcinoma, three (2.9%) had blastoma, three (2.9%) had sarcoma, and two (1.9%) had lymphoma. The majority (61.9%) of carcinoma cases were squamous cell carcinoma followed by anaplastic carcinoma (7.2%). Of the carcinoma cases, the most common site of primary lesion was larynx (19.6%), followed by the thyroid (14.4%), the tongue and hypopharynx with 10.3% cases each. Comparative analysis among males and females did not reveal any sex difference in type of head and neck cancers. The head and neck cancer pattern revealed by the present study provides valuable leads to cancer epidemiology in western Nepal and useful information for health planning and cancer control, and future research in western Nepal.

Bilateral calcified stylohyoid ligament: an incidental autopsy finding with medicolegal significance.

Eagle's syndrome occurs due to elongation of the styloid process or calcification of the stylohyoid ligament, which then may produce a pain sensation due to pressure exerted on various structures in the head and neck region. A case report of calcified stylohyoid ligament found incidentally at autopsy and further confirmed by computed tomography scan and histopathology is herein discussed with associated medicolegal significance.